COLUMBUS MEDICAL ASSOCIATION FOUNDATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COLUMBUS MEDICAL ASSOCIATION FOUNDATION (EIN 31-0679012)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-13
- IRS object ID
- 201833179349307163
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule F
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-13T16:04:26-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S HIGH ST SUITE 100 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 310679012 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLUMBUS MEDICAL ASSOCIATION FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COLU | BusinessNameControlTxt |
| Phone | 6142407410 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1390 DUBLIN ROAD | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT E FALCONE | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6142407410 | PhoneNum |
| Signature | 2018-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BERNIE OSTROWSKI | PreparerPersonNm |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2018-11-12 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.59.56.31 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-12 | IPDt |
| IP Tm | 08:38:13 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | CDA108602048A852A3C7A9C68094104E2D92ED46 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT E FALCONE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1390 DUBLIN ROAD | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,252,268 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CMAFOHIO.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1958 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 18 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $98,901 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $97,901 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $251,735 | PYContributionsGrantsAmt |
| CY Contributions Grants | $259,422 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $216,187 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $157,863 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,593,131 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,644,804 | CYInvestmentIncomeAmt |
| PY Other Revenue | $129,685 | PYOtherRevenueAmt |
| CY Other Revenue | $159,962 | CYOtherRevenueAmt |
| PY Total Revenue | $2,190,738 | PYTotalRevenueAmt |
| CY Total Revenue | $2,222,051 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,246,189 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,226,910 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $550,800 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $606,005 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $306,301 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,441,100 | PYOtherExpensesAmt |
| CY Other Expenses | $1,325,830 | CYOtherExpensesAmt |
| PY Total Expenses | $3,238,089 | PYTotalExpensesAmt |
| CY Total Expenses | $3,158,745 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,047,351 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$936,694 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $75,926,709 | TotalAssetsBOYAmt |
| Total Assets EOY | $83,451,624 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,733,304 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,229,057 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $72,193,405 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $80,222,567 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,601,442 | ExpenseAmt |
| Grant | $1,226,910 | GrantAmt |
| Revenue | $218,924 | RevenueAmt |
| Desc | THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION EXISTS TO EFFECT CHANGE WITHIN SPECIFIC PRIORITY AREAS TO IMPROVE THE HEALTH OF ALL CENTRAL OHIO RESIDENTS.PRIORITIES:- TRANSFORMING CLINICAL HEALTH CARE DELIVERY TO: BE PATIENT CENTERED, BE BASED ON HEALTH / WELLNESS PARADIGM, BE BASED ON CLEARLY DEFINED PATIENT / DOCTOR RESPONSIBILITY, BE A PARTNERSHIP BETWEEN PATIENT / DOCTOR / PAYER- SUPPORTING AND IMPROVING HEALTH CARE SAFETY NET CLINICAL SERVICES TO UNINSURED AND UNDERINSURED POPULATIONS SUCH AS SUPPORT FOR THE NEWLY CONSOLIDATED PHYSICIANS FREE CLINIC / VOLUNTARY CARE NETWORK. - SAVING AND IMPROVING LIVES THROUGH A COORDINATION OF TRAUMA AND EMERGENCY HEALTH CARE RESOURCES THROUGH SUPPORT FOR THE CENTRAL OHIO TRAUMA SYSTEM- ADVANCING LEADERSHIP CAPACITY OF YOUTH TO ENGAGE IN HEALTH PHILANTHROPY | Desc |
| Total Program Service Expenses | $1,601,442 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | Yes (1) | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | Yes (1) | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 24 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 18 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAURIE HAWKINS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6142407410 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1390 DUBLIN ROAD | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| JAMES L NICHOLS | |||||||
| SECRETARY/TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| LINDA SIEFKAS | |||||||
| VICE PRESIDENT | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARC L PARNES MD | |||||||
| PRESIDENT | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $5,000 | $0 |
| NEDRA HADLEY | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ALVIN RODACK | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| EDWARD T BOPE MD | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JASMINE GREEN | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MARK STAMM | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| BRET KOCKENTIET MD | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| GREG SAWCHYN MD | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| KAREN KING MD | |||||||
| TRUSTEE | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| CHARLOTTE AGNONE MD THRU MAY | |||||||
| TRUSTEE | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| BARBARA LACH | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| MYSHEIKA WILLIAMS ROBERTS MD | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JEFF HALL MD | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| DON BROWN | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| ANITA SOMANI MD | |||||||
| TRUSTEE | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| ROBERT E FALCONE MD | |||||||
| CEO | 24.00 | 16.00 | Yes (X) | $229,577 | $0 | $16,359 | |
| LAURIE HAWKINS | |||||||
| CFO | 22.00 | 18.00 | Yes (X) | $125,752 | $0 | $25,060 | |
| WELDON MILBOURNE | |||||||
| EXECUTIVE DIRECTOR | 39.00 | 1.00 | Yes (X) | $127,061 | $0 | $9,919 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $482,390 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,000 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $51,338 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $259,422 | AllOtherContributionsAmt |
| Total Contributions | $259,422 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| RENTAL INCOME | 900099 | $142,681 | $142,681 |
| PROGRAMS | 900099 | $15,182 | $15,182 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $157,863 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,645,327 | TotalRevenueColumnAmt |
| Exclusion | $1,645,327 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $76,500 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,694 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $46,806 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $46,806 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $46,806 | UnrelatedBusinessRevenueAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $523 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$523 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$523 | TotalRevenueColumnAmt |
| Exclusion | -$523 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| CAM | 900099 | $55,512 | $55,512 |
| INSURANCE PROCEEDS | 900099 | $5,549 | $5,549 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $52,095 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $52,095 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $113,156 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,222,051 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $218,924 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $98,901 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,644,804 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,226,910 | TotalAmt |
| Program Services | $1,226,910 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $116,170 | TotalAmt |
| Program Services | $34,851 | ProgramServicesAmt |
| Management And General | $56,923 | ManagementAndGeneralAmt |
| Fundraising | $24,396 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $285,122 | TotalAmt |
| Program Services | $85,536 | ProgramServicesAmt |
| Management And General | $139,710 | ManagementAndGeneralAmt |
| Fundraising | $59,876 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,360 | TotalAmt |
| Program Services | $14,208 | ProgramServicesAmt |
| Management And General | $23,206 | ManagementAndGeneralAmt |
| Fundraising | $9,946 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,328 | TotalAmt |
| Program Services | $29,498 | ProgramServicesAmt |
| Management And General | $48,181 | ManagementAndGeneralAmt |
| Fundraising | $20,649 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,025 | TotalAmt |
| Program Services | $17,708 | ProgramServicesAmt |
| Management And General | $28,922 | ManagementAndGeneralAmt |
| Fundraising | $12,395 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $450,092 | TotalAmt |
| Management And General | $450,092 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $194,858 | TotalAmt |
| Program Services | $50,663 | ProgramServicesAmt |
| Management And General | $89,635 | ManagementAndGeneralAmt |
| Fundraising | $54,560 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,429 | TotalAmt |
| Program Services | $40,153 | ProgramServicesAmt |
| Management And General | $14,122 | ManagementAndGeneralAmt |
| Fundraising | $40,154 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $619 | TotalAmt |
| Program Services | $11 | ProgramServicesAmt |
| Management And General | $597 | ManagementAndGeneralAmt |
| Fundraising | $11 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $216,843 | TotalAmt |
| Program Services | $59,019 | ProgramServicesAmt |
| Management And General | $116,397 | ManagementAndGeneralAmt |
| Fundraising | $41,427 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,600 | TotalAmt |
| Program Services | $64 | ProgramServicesAmt |
| Management And General | $3,472 | ManagementAndGeneralAmt |
| Fundraising | $64 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,890 | TotalAmt |
| Program Services | $26,405 | ProgramServicesAmt |
| Management And General | $30,078 | ManagementAndGeneralAmt |
| Fundraising | $26,407 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,674 | TotalAmt |
| Program Services | $1,564 | ProgramServicesAmt |
| Management And General | $84,547 | ManagementAndGeneralAmt |
| Fundraising | $1,563 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $183,034 | TotalAmt |
| Program Services | $14,642 | ProgramServicesAmt |
| Management And General | $153,749 | ManagementAndGeneralAmt |
| Fundraising | $14,643 | FundraisingAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TAXES & LICENSES | Desc |
| Total | $11,791 | TotalAmt |
| Program Services | $210 | ProgramServicesAmt |
| Management And General | $11,371 | ManagementAndGeneralAmt |
| Fundraising | $210 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,158,745 | TotalAmt |
| Program Services | $1,601,442 | ProgramServicesAmt |
| Management And General | $1,251,002 | ManagementAndGeneralAmt |
| Fundraising | $306,301 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $190,117 | BOYAmt |
| EOY | $242,280 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,415 | BOYAmt |
| EOY | $99,885 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,995 | BOYAmt |
| EOY | $40,636 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,291,887 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,319,159 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,071,736 | BOYAmt |
| EOY | $2,972,728 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,404,693 | BOYAmt |
| EOY | $79,985,899 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $107,753 | BOYAmt |
| EOY | $110,196 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,926,709 | BOYAmt |
| EOY | $83,451,624 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $339,732 | BOYAmt |
| EOY | $250,383 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $95,782 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,486,596 | BOYAmt |
| EOY | $2,385,467 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $811,194 | BOYAmt |
| EOY | $593,207 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,733,304 | BOYAmt |
| EOY | $3,229,057 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $71,152,106 | BOYAmt |
| EOY | $78,950,672 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $681,062 | BOYAmt |
| EOY | $808,658 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $360,237 | BOYAmt |
| EOY | $463,237 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,193,405 | BOYAmt |
| EOY | $80,222,567 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,926,709 | BOYAmt |
| EOY | $83,451,624 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$936,694 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $9,017,951 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$52,095 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type2 | Yes (X) | SupportingOrgType2Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200385860 | EIN |
| Organization Type | 10 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | Yes (1) | OrganizationChangeSuprtOrgInd |
| Supported Org Class Designated | 0 | SupportedOrgClassDesignatedInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Majority Dir Trst Supported Org | Yes (1) | MajorityDirTrstSupportedOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, SECTION A, LINE 5A: | FormAndLineReferenceDesc |
| Explanation | DURING 2017, COLUMBUS MEDICAL ASSOCATION FOUNDATION REMOVED COLUMBUS MEDICAL ASSOCIATION (FEIN 31-4411074) AS A SUPPORTED ORGANIZATION AND ADDED COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED (FEIN 20-0385860). THESE CHANGES WERE COMPLETED IN ORDER TO BETTER ALIGN THE MISSION WITH COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED. THE ARTICLES OF INCORPORATION WERE AMENDED TO ACCOMPLISH THESE CHANGES. ARTICLE 7 OF THE ARTICLES OF INCORPORATION GRANTS THE AUTHORITY FOR THE ORGANIZATION TO MAKE THESE CHANGES. | ExplanationTxt |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Donor Advised Funds Held | 9 | DonorAdvisedFundsHeldCnt |
| Funds And Other Accounts Held | 3 | FundsAndOtherAccountsHeldCnt |
| Donor Advised Funds Contri | $38,235 | DonorAdvisedFundsContriAmt |
| Funds And Other Accounts Contri | $103,000 | FundsAndOtherAccountsContriAmt |
| Donor Advised Funds Grants | $0 | DonorAdvisedFundsGrantsAmt |
| Funds And Other Accounts Grants | $14,017 | FundsAndOtherAccountsGrantsAmt |
| Donor Advised Funds Vl EOY | $918,378 | DonorAdvisedFundsVlEOYAmt |
| Funds And Other Accounts Vl EOY | $212,229 | FundsAndOtherAccountsVlEOYAmt |
| Disclosed Org Leg Ctrl | Yes (1) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (1) | DisclosedForCharitablePrpsInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,129,790 | BeginningYearBalanceAmt |
| Contributions | $95,934 | ContributionsAmt |
| Investment Earnings Or Losses | $160,398 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $68,597 | GrantsOrScholarshipsAmt |
| Other Expenditures | $510 | OtherExpendituresAmt |
| Administrative Expenses | $20,978 | AdministrativeExpensesAmt |
| End Year Balance | $2,296,037 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,128,618 | BeginningYearBalanceAmt |
| Contributions | $90,912 | ContributionsAmt |
| Investment Earnings Or Losses | $75,584 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $145,459 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $19,865 | AdministrativeExpensesAmt |
| End Year Balance | $2,129,790 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,479,300 | BeginningYearBalanceAmt |
| Contributions | $61,785 | ContributionsAmt |
| Investment Earnings Or Losses | $1,442 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $393,390 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $20,519 | AdministrativeExpensesAmt |
| End Year Balance | $2,128,618 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,715,353 | BeginningYearBalanceAmt |
| Contributions | $172,004 | ContributionsAmt |
| Investment Earnings Or Losses | $115,605 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $514,019 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $9,643 | AdministrativeExpensesAmt |
| End Year Balance | $2,479,300 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,779,131 | BeginningYearBalanceAmt |
| Contributions | $260,590 | ContributionsAmt |
| Investment Earnings Or Losses | $134,480 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $452,242 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $6,606 | AdministrativeExpensesAmt |
| End Year Balance | $2,715,353 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.14000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.23000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.63000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $253,580 | OtherCostOrOtherBasisAmt |
| Book Value | $253,580 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,047,215 | OtherCostOrOtherBasisAmt |
| Depreciation | $316,831 | DepreciationAmt |
| Book Value | $1,730,384 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,234,107 | OtherCostOrOtherBasisAmt |
| Depreciation | $369,653 | DepreciationAmt |
| Book Value | $864,454 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $558,436 | OtherCostOrOtherBasisAmt |
| Depreciation | $450,034 | DepreciationAmt |
| Book Value | $108,402 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $198,549 | OtherCostOrOtherBasisAmt |
| Depreciation | $182,641 | DepreciationAmt |
| Book Value | $15,908 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,972,728 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER SECURITIES | Desc |
| Book Value | $79,985,899 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $79,985,899 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| REIMBURSEMENT TO AFFILIATES | $317,879 |
| ASSETS HELD FOR OTHERS | $275,328 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $593,207 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | FUNDS SHALL BE USED TO MAKE GRANTS TO ELIGIBLE ORGANIZATIONS, PROGRAMS OR PROJECTS IN FURTHERANCE OF THE MISSION OF THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION. | ExplanationTxt |
Schedule F IRS990ScheduleF
Account Activities Outside US AccountActivitiesOutsideUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Region | ASIA | RegionTxt |
| Offices | 0 | OfficesCnt |
| Employee | 0 | EmployeeCnt |
| Type Of Activities Conducted | INVESTMENTS | TypeOfActivitiesConductedTxt |
| Specific Services Provided | N/A | SpecificServicesProvidedTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Offices | 0 | SubtotalOfficesCnt |
| Subtotal Employees | 0 | SubtotalEmployeesCnt |
| Continuation Total Office | 0 | ContinuationTotalOfficeCnt |
| Continuation Total Employee | 0 | ContinuationTotalEmployeeCnt |
| Total Office | 0 | TotalOfficeCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Subtotal Spent | $0 | SubtotalSpentAmt |
| Continuation Spent | $0 | ContinuationSpentAmt |
| Total Spent | $0 | TotalSpentAmt |
| Transfer To Foreign Corp | 0 | TransferToForeignCorpInd |
| Interest In Foreign Trust | 0 | InterestInForeignTrustInd |
| Foreign Corp Ownership | 0 | ForeignCorpOwnershipInd |
| Passive Foreign Investmest Co | 0 | PassiveForeignInvestmestCoInd |
| Foreign Partnership | 0 | ForeignPartnershipInd |
| Boycott Countries | 0 | BoycottCountriesInd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| HEALTHCARE COLLABORATIVE OF GREATER COLUMBUS | |||||||
| 1429 KING AVE SUITE 200 | COLUMBUS | OH | 43212 | 510426050 | 501 (C)(3) | $299,250 | TO SUPPORT ITS CORE SERVICES |
| CENTRAL OHIO TRAUMA SYSTEM | |||||||
| 1390 DUBLIN ROAD | COLUMBUS | OH | 43215 | 311592734 | 501 (C)(3) | $235,638 | TO SUPPORT ITS CORE SERVICES |
| PHYSICIANS CARE CONNECTION | |||||||
| 1390 DUBLIN ROAD | COLUMBUS | OH | 43215 | 311373719 | 501 (C)(3) | $492,817 | TO PROVIDE FREE PRIMARY & SPECIALTY MEDICAL CARE FOR THE UNINSURED AND UNDERSERVED |
| LOWER LIGHTS CHRISTIAN HEALTH | |||||||
| 1160 W BROAD STREEET | COLUMBUS | OH | 43222 | 311810355 | 501 (C)(3) | $10,000 | TO PROVIDE SUPPORT FOR THE CREATION OF NON-PROFIT GROCERY STORE AND CAFE |
| OHIO STATE UNIVERSITY FOUNDATION | |||||||
| 1480 W LANE AVENUE | COLUMBUS | OH | 43221 | 311145986 | 501 (C)(3) | $17,644 | TO SUPPORT MOMS2BE - PROJECT MINDFULL, WHICH INCLUDES MENTAL HEALTH SERVICES TO PREGNANT WOMEN |
| OHIO PSYCHIATRIC PHYSICIANS FOUNDATION | |||||||
| 3510 SNOUFFER ROAD | COLUMBUS | OH | 43235 | 316181034 | 501 (C)(3) | $10,000 | STUDY TO EXAMINE MEDICAL TRAINEES' DEPRESSION AND PERCEPTION OF THE CULTURE WITHIN THEIR PROGRAM TO ENCOURAGE AWARENESS OF DEPRESSION AND INTERVENTION WHEN APPROPRIATE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 6 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | A MEMORANDUM OF AGREEMENT IS SIGNED BETWEEN THE GRANTEE AND GRANTOR THAT DESCRIBES THE CONDITIONS FOR THE GRANT TO INCLUDE PAYMENT AND REPORTING PROCESSES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT E FALCONE MD | ||||||||||||||
| CEO | $229,577 | $0 | $0 | $0 | $0 | $0 | $13,380 | $0 | $2,979 | $0 | $245,936 | $0 | $0 | $0 |
| LAURIE HAWKINS | ||||||||||||||
| CFO | $125,752 | $0 | $0 | $0 | $0 | $0 | $7,825 | $0 | $17,235 | $0 | $150,812 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | ARTICLES OF INCORPORATION WERE RESTATED TO SHOW THE SUPPORTED ORGANIZATION OF THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION CHANGE FROM THE COLUMBUS MEDICAL ASSOCIATION TO THE COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED. |
| FORM 990, PART VI, SECTION A, LINE 6 | COLUMBUS MEDICAL ASSOCIATION IS THE ORGANIZATION'S SOLE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER HAS THE AUTHORITY TO ELECT AND REMOVE DIRECTORS AND APPROVE CHANGES IN THE BY-LAWS AND CODE OF REGULATIONS. IN ADDITION THE SOLE MEMBER HAS THE AUTHORITY TO APPROVE DECISIONS SUCH AS DISSOLVING THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN IS PROVIDED TO THE BOARD MEMBERS FOR THEIR REVIEW BEFORE THE RETURN IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION ANNUALLY SENDS A DISCLOSURE FORM TO ALL DIRECTORS, OFFICERS, AND KEY EMPLOYEES REQUIRING THEM TO DISCLOSE ANY CONFLICTS OF INTEREST. ANY NEW BOARD MEMBERS ARE ADVISED OF THE POLICY UPON ENTERING THE DUTIES OF HIS/HER OFFICE. THOSE CONFLICTS ARE THEN ADDRESSED BY THE BOARD. VOTING AND PARTICIPATION RESTRICTIONS ARE IMPOSED ON THOSE WITH ANY CONFLICTS. THE BOARD CHAIRPERSON AND SECRETARY/TREASURER ARE AUTHORIZED AND DIRECTED TO SEE THAT THIS POLICY IS FOLLOWED. |
| FORM 990, PART VI, SECTION B, LINE 15 | COLUMBUS MEDICAL ASSOCIATION AND COLUMBUS MEDICAL ASSOCIATION FOUNDATION PERFORM THE COMPENSATION REVIEWS. THE BOARD OF DIRECTORS REVIEWS THE CEO'S COMPENSATION. THEN THE CEO REVIEWS THE COMPENSATION OF ALL OF THE STAFF. THE BOARD AND CEO ESTABLISH COMPENSATION BASED ON AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD. THE LAST COMPENSATION REVIEW WAS IN 2015 AND WILL BE UPDATED IN 2018. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | UNRELATED BUSINESS INCOME FROM INVESTMENT IN PARTNERSHIPS -52,095. |
| FORM 990, PART XII, LINE 2C | THE TREASURERS OF THE FILING ORGANIZATION AND ITS RELATED ENTITIES ARE MEMBERS OF THE JOINT FINANCE COMMITTEE. THIS COMMITTEE MAKES DECISIONS CONCERNING THE SELECTION OF THE INDEPENDENT AUDITORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| COLUMBUS MEDICAL ASSOCIATION FOUNDATION UNLIMITED | |||||||||||
| 1390 DUBLIN ROAD | COLUMBUS | OH | 43215 | 200385860 | PROVIDING HEALTH AND WELLNESS SERVICES | OH | 501(C)(3) | LINE 7 | COLUMBUS MEDICAL ASSOCIATION | Yes (1) | |
| COLUMBUS MEDICAL ASSOCIATION | |||||||||||
| 1390 DUBLIN ROAD | COLUMBUS | OH | 43215 | 314411074 | ADVANCING COMMUNITY HEALTH THROUGH ADVOCACY, EDUCATION AND SERVICE | OH | 501(C)(6) | 0 | N/A | ||
| CENTAL OHIO TRAUMA SYSTEM | |||||||||||
| 1390 DUBLIN ROAD | COLUMBUS | OH | 43215 | 311592734 | REDUCING INJURIES AND SAVING LIVES BY IMPROVING TRAUMA CARE | OH | 501(C)(3) | LINE 7 | COLUMBUS MEDICAL ASSOCIATION | Yes (1) | |
| PHYSICIANS CARE CONNECTION | |||||||||||
| 1390 DUBLIN ROAD | COLUMBUS | OH | 43215 | 311373719 | COORDINATING VOLUNTARY HEALTH CARE SERVICES | OH | 501(C)(3) | LINE 3 | COLUMBUS MEDICAL ASSOCIATION | Yes (1) | |
| PHYSICIANS LEADERSHIP ACADEMY | |||||||||||
| 1390 DUBLIN ROAD | COLUMBUS | OH | 43215 | 822152009 | SUPPORT PHYSICIANS WITH LEADERSHIP TRAINING | OH | 501(C)(3) | LINE 2 | COLUMBUS MEDICAL ASSOCIATION | Yes (1) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CENTRAL OHIO TRAUMA SYSTEMS | ||
| B | $235,638 | GRANT |
| PHYSICIANS CARE CONNECTION | ||
| B | $492,817 | GRANT |
| CENTRAL OHIO TRAUMA SYSTEMS | ||
| A | $80,067 | PER SQ FT |
| COLUMBUS MEDICAL ASSOCIATION | ||
| O | $75,877 | AGREED UPON % OF TIME |
| CENTRAL OHIO TRAUMA SYSTEMS | ||
| O | $150,738 | AGREED UPON % OF TIME |
| PHYSICIANS CARE CONNECTION | ||
| O | $169,931 | AGREED UPON % OF TIME |
| COLUMBUS MEDICAL ASSOCIATION | ||
| A | $12,865 | PER SQ FT |
| PHYSICIANS CARE CONNECTION | ||
| A | $49,749 | PER SQ FT |
| PHYSICIANS LEADERSHIP ACADEMY | ||
| D | $184,000 | LOAN |